Here are some answers about a drug that treats addiction

Suboxone Q and A with Chase Adams, a recovering addict using Suboxone, with Molly Rutherford MD, a Bluegrass Family physician who has been prescribing Suboxone for years.
Liz Moughon/CJ

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Dr. Molly Rutherford gives recovering addict patients Suboxone to help combat their addictions. Overtime Rutherford decreases the amount of Suboxone she gives and has seen many positive improvements. Rutherford views drug usage as any other disease that will not be fought without some medication.(Photo11: Liz Moughon/CJ)Buy Photo

It’s an opioid medication designed to reduce cravings for opioids such as illicit prescription painkillers and heroin. It can come in a pill form or a film placed under the tongue. The most well-known brands are Suboxone, which includes buprenorphine and naloxone (to deter abuse); and Subutex, which doesn’t include naloxone. Unlike methadone treatment, which must be done in a structured clinic, buprenorphine is the first opioid dependency treatment medication that can be prescribed or dispensed in a doctor's office.

Buprenorphine interacts with brain receptors affected by opioid drugs like heroin, helping diminish the effects of physical dependency to these drugs, such as withdrawal symptoms and cravings. As an “opioid partial agonist,” which means it activates opioid receptors in the brain, but less than drugs like heroin. So although it causes euphoria and respiratory depression, these effects are weaker. Buprenorphine’s opioid effects increase with each dose until leveling off at moderate doses, even if doses are increased. This “ceiling effect” lowers the risk of misuse, dependency and side effects such as nausea, muscle aches and sleeplessness.

How do patients take the medicine?

The treatment happens in three phases. The first is the induction phase, in which treatment is begun in a doctor’s office after the patient has abstained from other opioids for 12 to 24 hours. The second is the stabilization phase, which begins when a patient no longer has cravings for the abused drug and experiences few or no side effects. The dose may need to be adjusted during this phase. Finally, there’s the maintenance phase, when a patient does well on a steady dose. The length of time for this phase is tailored to the patient and can be indefinite — although some doctors disagree with indefinite use and say the drug should always be tapered off.

How well does it work?

People are divided on this question. The Substance Abuse and Mental Health Services Administration says when it’s combined with counseling and behavioral therapies, it “provides a whole-patient approach” to treatment, is safe and effective and represents “the latest advance in medication-assisted treatment.” Some doctors, patients and addiction experts agree it works well at curbing cravings and aiding recovery. But other doctors, experts and patients say it replaces one opioid for another, is frequently abused and diverted by patients and is not as effective as abstinence-based addiction treatment. Many say both types of treatment should be available because different types work for different people.

What are buprenorphine’s side effects?

They can include: nausea, vomiting, and constipation; muscle aches and cramps, cravings; inability to sleep; distress and irritability; and fever.

Can patients misuse buprenorphine?

Yes. It’s an opioid. Naloxone is added to Suboxone to decrease the likelihood of misuse, but the danger is still there, and many addicts do report abusing it. If the medication is crushed and injected, the naloxone effect dominates and can bring on opioid withdrawals.

What about interactions with other drugs?

It’s dangerous to mix buprenorphine with illegal drugs, alcohol, sedatives or other drugs that slow breathing. Some addicts, including those in recovery, report doing this despite the dangers. Mixing large amounts of medications with buprenorphine can lead to overdose or death.

Medication-assisted addiction treatment with Suboxone is gaining popularity in Kentucky and across the nation. But Suboxone is an opioid, so it's possible to abuse it. Close monitoring and responsible prescribing is key.
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